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Liu Z, Meng Z, Wei D, Qin Y, Lv Y, Xie L, Qiu H, Xie B, Li L, Wei X, Zhang D, Liang B, Li W, Qin S, Yan T, Meng Q, Wei H, Jiang G, Su L, Jiang N, Zhang K, Lv J, Hu Y. Predictive model and risk analysis for coronary heart disease in people living with HIV using machine learning. BMC Med Inform Decis Mak 2024; 24:110. [PMID: 38664736 PMCID: PMC11046885 DOI: 10.1186/s12911-024-02511-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE This study aimed to construct a coronary heart disease (CHD) risk-prediction model in people living with human immunodeficiency virus (PLHIV) with the help of machine learning (ML) per electronic medical records (EMRs). METHODS Sixty-one medical characteristics (including demography information, laboratory measurements, and complicating disease) readily available from EMRs were retained for clinical analysis. These characteristics further aided the development of prediction models by using seven ML algorithms [light gradient-boosting machine (LightGBM), support vector machine (SVM), eXtreme gradient boosting (XGBoost), adaptive boosting (AdaBoost), decision tree, multilayer perceptron (MLP), and logistic regression]. The performance of this model was assessed using the area under the receiver operating characteristic curve (AUC). Shapley additive explanation (SHAP) was further applied to interpret the findings of the best-performing model. RESULTS The LightGBM model exhibited the highest AUC (0.849; 95% CI, 0.814-0.883). Additionally, the SHAP plot per the LightGBM depicted that age, heart failure, hypertension, glucose, serum creatinine, indirect bilirubin, serum uric acid, and amylase can help identify PLHIV who were at a high or low risk of developing CHD. CONCLUSION This study developed a CHD risk prediction model for PLHIV utilizing ML techniques and EMR data. The LightGBM model exhibited improved comprehensive performance and thus had higher reliability in assessing the risk predictors of CHD. Hence, it can potentially facilitate the development of clinical management techniques for PLHIV care in the era of EMRs.
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Affiliation(s)
- Zengjing Liu
- Information and Management College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Zhihao Meng
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, Guangxi, 545005, China
| | - Di Wei
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, Guangxi, 545005, China
| | - Yuan Qin
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, Guangxi, 545005, China
| | - Yu Lv
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, Guangxi, 545005, China
| | - Luman Xie
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, Guangxi, 545005, China
| | - Hong Qiu
- Life Sciences College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Bo Xie
- Information and Management College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Lanxiang Li
- Basic Medical College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Xihua Wei
- Life Sciences College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Die Zhang
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co- constructed by the Province, Ministry of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Boying Liang
- Basic Medical College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Wen Li
- Life Sciences College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Shanfang Qin
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, Guangxi, 545005, China
| | - Tengyue Yan
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co- constructed by the Province, Ministry of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Qiuxia Meng
- Information and Management College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Huilin Wei
- Life Sciences College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Guiyang Jiang
- Department of rehabilitation medicine, Department of the First affliated hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Lingsong Su
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, Guangxi, 545005, China
| | - Nili Jiang
- Life Sciences College of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Kai Zhang
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, Guangxi, 545005, China.
| | - Jiannan Lv
- Affiliate Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, 533000, China.
| | - Yanling Hu
- Information and Management College of Guangxi Medical University, Nanning, Guangxi, 530021, China.
- Life Sciences College of Guangxi Medical University, Nanning, Guangxi, 530021, China.
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co- constructed by the Province, Ministry of Guangxi Medical University, Nanning, Guangxi, 530021, China.
- Faculty of Data science, City University of Macau, 999078, Macau, China.
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Silverberg MJ, Pimentel N, Leyden WA, Leong TK, Reynolds K, Ambrosy AP, Towner WJ, Hechter RC, Horberg M, Vupputuri S, Harrison TN, Lea AN, Sung SH, Go AS, Neugebauer R. Initial antiretroviral therapy regimen and risk of heart failure. AIDS 2024; 38:547-556. [PMID: 37967231 PMCID: PMC10922375 DOI: 10.1097/qad.0000000000003786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
OBJECTIVES Heart failure risk is elevated in people with HIV (PWH). We investigated whether initial antiretroviral therapy (ART) regimens influenced heart failure risk. DESIGN Cohort study. METHODS PWH who initiated an ART regimen between 2000 and 2016 were identified from three integrated healthcare systems. We evaluated heart failure risk by protease inhibitor, nonnucleoside reverse transcriptase inhibitors (NNRTI), and integrase strand transfer inhibitor (INSTI)-based ART, and comparing two common nucleotide reverse transcriptase inhibitors: tenofovir disoproxil fumarate (tenofovir) and abacavir. Follow-up for each pairwise comparison varied (i.e. 7 years for protease inhibitor vs. NNRTI; 5 years for tenofovir vs. abacavir; 2 years for INSTIs vs. PIs or NNRTIs). Hazard ratios were from working logistic marginal structural models, fitted with inverse probability weighting to adjust for demographics, and traditional cardiovascular risk factors. RESULTS Thirteen thousand six hundred and thirty-four PWH were included (88% men, median 40 years of age; 34% non-Hispanic white, 24% non-Hispanic black, and 24% Hispanic). The hazard ratio (95% CI) were: 2.5 (1.5-4.3) for protease inhibitor vs. NNRTI-based ART (reference); 0.5 (0.2-1.8) for protease inhibitor vs. INSTI-based ART (reference); 0.1 (0.1-0.8) for NNRTI vs. INSTI-based ART (reference); and 1.7 (0.5-5.7) for tenofovir vs. abacavir (reference). In more complex models of cumulative incidence that accounted for possible nonproportional hazards over time, the only remaining finding was evidence of a higher risk of heart failure for protease inhibitor compared with NNRTI-based regimens (1.8 vs. 0.8%; P = 0.002). CONCLUSION PWH initiating protease inhibitors may be at higher risk of heart failure compared with those initiating NNRTIs. Future studies with longer follow-up with INSTI-based and other specific ART are warranted.
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Affiliation(s)
- Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena
- Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco
| | - Noel Pimentel
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Wendy A Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Thomas K Leong
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Kristi Reynolds
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Andrew P Ambrosy
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco
| | - William J Towner
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Infectious Diseases, Kaiser Permanente Los Angeles Medical Center, Los Angeles
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Rulin C Hechter
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Michael Horberg
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena
- Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD
| | - Suma Vupputuri
- Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD
| | - Teresa N Harrison
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Alexandra N Lea
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena
- Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco
- Departments of Medicine, Health Research and Policy, Stanford University, Palo Alto, CA, USA
| | - Romain Neugebauer
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena
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Lam JO, Leyden WA, Alexeeff S, Lea AN, Hechter RC, Hu H, Marcus JL, Pitts L, Yuan Q, Towner WJ, Horberg MA, Silverberg MJ. Changes in Body Mass Index Over Time in People With and Without HIV Infection. Open Forum Infect Dis 2024; 11:ofad611. [PMID: 38323078 PMCID: PMC10846771 DOI: 10.1093/ofid/ofad611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/01/2023] [Indexed: 02/08/2024] Open
Abstract
Background Excess weight gain is an important health concern among people with HIV (PWH) on antiretroviral therapy (ART). The extent to which ART contributes to body mass index (BMI) changes is incompletely understood. Methods We conducted a retrospective study of PWH initiating ART and demographically matched people without HIV (PWoH). Data on baseline BMI (kg/m2; categorized as underweight/normal, overweight, or obese) and ART class (integrase strand transfer inhibitor [INSTI], non-nucleoside reverse transcriptase inhibitor [NNRTI], protease inhibitor [PI]) were obtained from electronic health records. BMI was evaluated longitudinally using piecewise linear splines in mixed effects models by HIV status, baseline BMI, and ART class. Models were adjusted for sociodemographics, comorbidities, and substance use. Results The study included 8256 PWH and 129 966 PWoH (mean baseline age, 40.9 and 42.2 years, respectively; 88% men). In adjusted models, the average annual change in BMI in the first 2 years after ART initiation was 0.53 for PWH and 0.12 for PWoH (P < .001). BMI increases among PWH were observed for all ART classes: 0.69 for INSTIs, 0.69 for PIs, and 0.40 for NNRTIs vs 0.12 among PWoH. For PWH initiating INSTIs, BMI increases were observed regardless of baseline BMI. Overall BMI changes >2 years after ART initiation were similar by HIV status (0.02 average annual increase for PWH and PWoH). Conclusions PWH initiating ART gained excess weight in the first 2 years, emphasizing the importance of monitoring weight and cardiometabolic health among ART-treated PWH.
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Affiliation(s)
- Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Wendy A Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Stacey Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Alexandra N Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Haihong Hu
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Lakecia Pitts
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Qing Yuan
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - William J Towner
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Michael A Horberg
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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4
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Silverberg MJ, Levine TM, Lea AN, Williams AE, Alexeeff SE, Bryant K, Cavassini M, Flamm JA, Hare CB, Ingle SM, Justice AC, Lam JO, Sterling SA, Horberg MA, Satre DD. Cardiovascular Disease Risk Factor Control in People With and Without Human Immunodeficiency Virus. Clin Infect Dis 2024:ciad728. [PMID: 38227614 DOI: 10.1093/cid/ciad728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Management of hypertension, dyslipidemia, diabetes and other modifiable factors may mitigate the cardiovascular disease (CVD) risk in people with human immunodeficiency virus (HIV, PWH) compared with people without HIV (PWoH). METHODS This was a retrospective cohort study of 8285 PWH and 170 517 PWoH from an integrated health system. Risk factor control was measured using a novel disease management index (DMI) accounting for amount/duration above treatment goals (0% to 100% [perfect control]), including 2 DMIs for hypertension (diastolic and systolic blood pressure), 3 for dyslipidemia (low-density lipoprotein, total cholesterol, triglycerides), and 1 for diabetes (HbA1c). CVD risk by HIV status was evaluated overall and in subgroups defined by DMIs, smoking, alcohol use, and overweight/obesity in adjusted Cox proportional hazards models. RESULTS PWH and PWoH had similar DMIs (80%-100%) except for triglycerides (worse for PWH) and HbA1c (better for PWH). In adjusted models, PWH had an elevated risk of CVD compared with PWoH (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.07-1.31). This association was attenuated in subgroups with controlled dyslipidemia and diabetes but remained elevated for PWH with controlled hypertension or higher total cholesterol. The strongest HIV status association with CVD was seen in the subgroup with frequent unhealthy alcohol use (HR, 2.13; 95% CI, 1.04-4.34). CONCLUSIONS Control of dyslipidemia and diabetes, but not hypertension, attenuated the HIV status association with CVD. The strong association of HIV and CVD with frequent unhealthy alcohol use suggests enhanced screening and treatment of alcohol problems in PWH is warranted.
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Affiliation(s)
- Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Tory M Levine
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Alexandra N Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Andrew E Williams
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
| | - Matthias Cavassini
- Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Jason A Flamm
- Kaiser Permanente Sacramento Medical Center, Sacramento, California, USA
| | - C Bradley Hare
- Kaiser Permanente SanFrancisco Medical Center, San Francisco, California, USA
| | - Suzanne M Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Amy C Justice
- VA Connecticut Healthcare System, Yale University Schools of Medicine and Public Health, New Haven, Connecticut, USA
| | - Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, SanFrancisco, California, USA
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Lam JO, Leyden WA, Leong TK, Horberg MA, Reynolds K, Ambrosy AP, Avula HR, Hechter RC, Towner WJ, Vupputuri S, Go AS, Silverberg MJ. Variation in Heart Failure Risk by HIV Severity and Sex in People With HIV Infection. J Acquir Immune Defic Syndr 2022; 91:175-181. [PMID: 36094484 PMCID: PMC9471068 DOI: 10.1097/qai.0000000000003032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV is an independent risk factor for heart failure (HF). However, the association of HIV severity with incident HF and the potential interaction with sex are incompletely understood. SETTING Integrated health care system. METHODS We conducted a cohort study of people with HIV (PWH) and matched people without HIV (PWoH), all aged ≥ 21 years and with no previous HF. Poisson regression was used to compare incident HF by HIV status, with PWH stratified by severity of HIV infection [defined by recent (<6 months) CD4 count, nadir CD4 count, or recent HIV RNA level]. Models were adjusted for sociodemographic characteristics, substance use, and HF risk factors. Analyses were conducted for men and women combined, then by sex. RESULTS The study included 38,868 PWH and 386,569 PWoH (mean baseline age = 41.0 ± 10.8 years; 88% men). Compared with PWoH, incident HF risk was higher among PWH with lower recent CD4 [200-499 cells/µL, adjusted rate ratio (aRR) = 1.82, 95% confidence interval (CI) = 1.50 to 2.21 and <200 cells/µL, aRR = 3.26 (2.47 to 4.30)] and a low nadir CD4 [<200 cells/µL, aRR = 1.56 (1.37 to 1.79)] but not among PWH with normal CD4 [≥500 cells/µL, aRR = 1.14 (0.90 to 1.44)]. Higher incident HF risk was observed among PWH at all HIV RNA levels, with greater HF risk at higher HIV RNA levels. The excess HF risk associated with low CD4 (recent or nadir) and high HIV RNA was stronger among women than men (P interactions=0.05, 0.08, and 0.01, respectively). CONCLUSIONS Given the association of HIV severity with HF, optimizing HIV treatment and management may be important for HF prevention among PWH.
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Affiliation(s)
- Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Wendy A Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Thomas K Leong
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Andrew P Ambrosy
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Department of Cardiology, Kaiser Permanente Northern California, San Francisco Medical Center, San Francisco, CA
| | - Harshith R Avula
- Department of Cardiology, Dublin Medical Offices, Kaiser Permanente Northern California, Dublin, CA
- Department of Cardiology, Walnut Creek Medical Center, Kaiser Permanente Northern California, Walnut Creek, CA
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - William J Towner
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA; and
| | - Suma Vupputuri
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
- Departments of Epidemiology, Biostatistics, and Medicine, University of California, San Francisco, San Francisco, CA
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
- Departments of Epidemiology, Biostatistics, and Medicine, University of California, San Francisco, San Francisco, CA
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Go AS, Tan TC, Horiuchi KM, Laws D, Ambrosy AP, Lee KK, Maring BL, Joy J, Couch C, Hepfer P, Lo JC, Parikh RV. Effect of Medically Tailored Meals on Clinical Outcomes in Recently Hospitalized High-Risk Adults. Med Care 2022; 60:750-758. [PMID: 35972131 PMCID: PMC9451942 DOI: 10.1097/mlr.0000000000001759] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Inability to adhere to nutritional recommendations is common and linked to worse outcomes in patients with nutrition-sensitive conditions. OBJECTIVES The purpose of this study is to evaluate whether medically tailored meals (MTMs) improve outcomes in recently discharged adults with nutrition-sensitive conditions compared with usual care. RESEARCH DESIGN Remote pragmatic randomized trial. SUBJECTS Adults with heart failure, diabetes, or chronic kidney disease being discharged home between April 27, 2020, and June 9, 2021, from 5 hospitals within an integrated health care delivery system. MEASURES Participants were prerandomized to 10 weeks of MTMs (with or without virtual nutritional counseling) compared with usual care. The primary outcome was all-cause hospitalization within 90 days after discharge. Exploratory outcomes included all-cause and cause-specific health care utilization and all-cause death within 90 days after discharge. RESULTS A total of 1977 participants (MTMs: n=993, with 497 assigned to also receive virtual nutritional counseling; usual care: n=984) were enrolled. Compared with usual care, MTMs did not reduce all-cause hospitalization at 90 days after discharge [adjusted hazard ratio, aHR: 1.02, 95% confidence interval (CI), 0.86-1.21]. In exploratory analyses, MTMs were associated with lower mortality (aHR: 0.65, 95% CI, 0.43-0.98) and fewer hospitalizations for heart failure (aHR: 0.53, 95% CI, 0.33-0.88), but not for any emergency department visits (aHR: 0.95, 95% CI, 0.78-1.15) or diabetes-related hospitalizations (aHR: 0.75, 95% CI, 0.31-1.82). No additional benefit was observed with virtual nutritional counseling. CONCLUSIONS Provision of MTMs after discharge did not reduce risk of all-cause hospitalization in adults with nutrition-sensitive conditions. Additional large-scale randomized controlled trials are needed to definitively determine the impact of MTMs on survival and cause-specific health care utilization in at-risk individuals.
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Affiliation(s)
- Alan S. Go
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena
- Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco
- Department of Medicine (Nephrology), Stanford University School of Medicine, Palo Alto
| | - Thida C. Tan
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Kate M. Horiuchi
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Denise Laws
- Kaiser Permanente Santa Rosa Medical Center, Santa Rosa
| | - Andrew P. Ambrosy
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco
| | - Keane K. Lee
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara
| | - Benjamin L. Maring
- Department of Internal Medicine, Kaiser Permanente Oakland Medical Center, Oakland
| | - Jena Joy
- Department of Internal Medicine, Kaiser Permanente Oakland Medical Center, Oakland
| | | | | | - Joan C. Lo
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena
- Division of Endocrinology, Kaiser Permanente Oakland Medical Center, Oakland, CA
| | - Rishi V. Parikh
- Division of Research, Kaiser Permanente Northern California, Oakland
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Abstract
PURPOSE OF REVIEW To synthesize current evidence on the impact of cardiovascular disease among women living with HIV (WLWH) with a particular focus on disease prevalence, mechanisms and prevention. RECENT FINDINGS HIV-related cardiovascular disease risk is 1.5-fold to 2-fold higher for women than for men. Mechanisms of enhanced risk are multifactorial and include reinforcing pathways between traditional risk factors, metabolic dysregulation, early reproductive aging and chronic immune activation. These pathways influence both the presentation of overt syndromes of myocardial infarction, stroke and heart failure, as well as subclinical disease, such as microvascular dysfunction and cardiac fibrosis. Cardiovascular disease, therefore, remains a consistent threat to healthy aging among WLWH. SUMMARY Although no specific prevention strategies exist, patient-centered risk mitigation approaches that are adaptable to the needs of aging individuals are essential to combat disparities in cardiovascular outcomes among WLWH. Further research into the optimal prevention approach for CVD among WLWH, particularly for women living in under-resourced health systems, is needed.
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Affiliation(s)
- Katherine Kentoffio
- Department of Medicine, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Tecla M Temu
- Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
| | - Saate S Shakil
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Markella V. Zanni
- Department of Medicine, Division of Endocrinology, Massachusetts General Hospital, Boston, MA, USA
| | - Chris T. Longenecker
- Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, USA
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8
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Abstract
PURPOSE OF REVIEW To summarize the state-of-the-art literature on the epidemiology, disease progression, and mediators of heart failure, tachyarrhythmias, and sudden cardiac death in people living with HIV (PLWH) to inform prevention strategies. RECENT FINDINGS Recent studies corroborate the role of HIV as a risk enhancer for heart failure and arrhythmias, which persists despite adjustment for cardiovascular risk factors and unhealthy behaviors. Immune activation and inflammation contribute to the risk. Heart failure occurs more frequently at younger ages, and among women and ethnic minorities living with HIV, highlighting disparities. Prospective outcome studies remain sparse in PLWH limiting prevention approaches. However, subclinical cardiac and electrophysiologic remodeling and dysfunction detected by noninvasive testing are powerful disease surrogates that inform our mechanistic understanding of HIV-associated cardiovascular disease and offer opportunities for early diagnosis. SUMMARY Aggressive control of HIV viremia and cardiac risk factors and abstinence from unhealthy behaviors remain treatment pillars to prevent heart failure and arrhythmic complications. The excess risk among PLWH warrants heightened vigilance for heart failure and arrhythmic symptomatology and earlier testing as subclinical abnormalities are common. Future research needs include identifying novel therapeutic targets to prevent heart failure and arrhythmias and testing of interventions in diverse groups of PLWH.
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Affiliation(s)
- Katherine C. Wu
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD
| | - Bethel Woldu
- MedStar Heart and Vascular Institute, Baltimore, MD
- MedStar Georgetown University, Department of Medicine, Division of Cardiology, Washington DC
| | - Wendy S. Post
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD
| | - Allison G. Hays
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD
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Mefford MT, Silverberg MJ, Leong TK, Hechter RC, Towner WJ, Go AS, Horberg M, Hu H, Harrison TN, Sung SH, Reynolds K. Multimorbidity Burden and Incident Heart Failure Among People With and Without HIV: The HIV-HEART Study. Mayo Clin Proc Innov Qual Outcomes 2022; 6:218-227. [PMID: 35539894 PMCID: PMC9079699 DOI: 10.1016/j.mayocpiqo.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To examine the association between multimorbidity burden and incident heart failure (HF) among people with HIV (PWH) and people without HIV (PWoH). Patients and Methods The HIV-HEART study is a retrospective cohort study that included adult PWH and PWoH aged 21 years or older at Kaiser Permanente between 2000 and 2016. Multimorbidity burden was defined by the baseline prevalence of 22 chronic conditions and was categorized as 0-1, 2-3, and 4 or more comorbidities on the basis of distribution of the overall population. People with HIV and PWoH were followed for a first HF event, all-cause death, or up to the end of follow-up on December 31, 2016. Using Cox proportional hazard regression, hazard ratios and 95% CIs were calculated to examine the association between multimorbidity burden and incident HF among PWH and PWoH, separately. Results The prevalences of 0-1, 2-3, and 4 or more comorbidities were 83.3%, 13.0%, and 3.7% in PWH (n=38,868), and 82.2%, 14.3%, and 3.5% in PWoH (n=386,586), respectively. After multivariable adjustment, compared with people with 0-1 comorbidities, the hazard ratios of incident HF associated with 2-3 and 4 or more comorbidities were 1.33 (95% CI, 1.04-1.71) and 2.41 (95% CI, 1.78-3.25) in PWH and 2.10 (95% CI, 1.92-2.29) and 4.09 (95% CI, 3.64-4.61) in PWoH, respectively. Conclusion Multimorbidity was associated with a higher risk of incident HF among PWH and PWoH, with more prominent associations in PWoH and certain patient subgroups. The identification of specific multimorbidity patterns that contribute to higher HF risk in PWH may lead to future preventative strategies.
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Affiliation(s)
- Matthew T Mefford
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.,Departments of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Thomas K Leong
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.,Department of Epidemiology, University of California Los Angeles, Los Angeles, CA
| | - William J Towner
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.,Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.,Department of Infectious Disease, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.,Departments of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.,Department of Medicine, University of California, San Francisco, CA.,Department of Medicine, Stanford University, Palo Alto, CA
| | - Michael Horberg
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.,Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
| | - Haihong Hu
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
| | - Teresa N Harrison
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
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Faaborg-Andersen C, daSilva-deAbreu A, Ventura HO. Understanding Heart Failure Risk in a Diverse Cohort With Human Immunodeficiency Virus Infection. Mayo Clin Proc 2022; 97:433-435. [PMID: 35246281 DOI: 10.1016/j.mayocp.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/20/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Adrian daSilva-deAbreu
- Heart and Vascular Center, Yale-New Haven Hospital, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA.
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